Abstract 4367548: Non-Inferior Safety of Same-Day Discharge Following Percutaneous Left Atrial Appendage Closure: An Updated Meta-Analysis

Background: Same-day discharge (SDD) protocols are increasingly adopted in structural heart interventions due to their potential to reduce hospital length of stay and associated clinical and economic burdens. This meta-analysis evaluates the safety of SDD compared to overnight hospitalization (>24 hours) following percutaneous left atrial appendage closure (LAAC). Methods: We systematically searched PubMed, Scopus, Web of Science, Embase, and the Cochrane Library from inception through April 2025 for studies comparing SDD and non-SDD protocols in patients undergoing LAAC. The primary outcome was a composite of major complications (death, stroke, and major bleeding) through final follow-up. Secondary outcomes included individual components of the composite, readmission, pericardial effusion, device-related thrombosis, and peridevice leak. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using RevMan software, with p-values <0.05 considered statistically significant. Results: Seven observational studies (SDD: n=1,590; mean age 76.8 years; 38.8% female; non-SDD: n=55,192; mean age 76.6 years; 42.3% female) were included. The risk of major complications was not significantly different between groups (RR 0.72, 95% CI 0.52–1.00, p =0.05). No significant differences were observed in individual outcomes including death (RR 0.81, p =0.52), stroke (RR 0.39, p =0.16), and major bleeding (RR 0.85, p =0.44). SDD was also comparable in terms of readmission (RR 1.02, p =0.87), device-related thrombosis (RR 1.86, p =0.57), pericardial effusion (RR 0.22, p =0.08), and peridevice leak (RR 0.70, p =0.35). Conclusions: Despite the observational nature of included studies and potential for selection bias, same-day discharge appears non-inferior to extended hospitalization in terms of safety following LAAC. These findings support the feasibility of SDD protocols and underscore the need for prospective randomized trials in well-selected patient populations.